肝癌切除术后并发症的多元回归分析

Multivariate regression analysis of postoperative complications of resection of hepatocellular carcinoma

目的研究与肝癌切除术后并发症发生有关的因素,并探讨减少肝癌切除术后并发症的技术要点。方法回顾性总结1988年6月至2005年4月间连续施行的378例肝癌切除病例,采用单因素分析和多元逐步回归模型分析与肝癌切除术后并发症有关的因素。结果肝癌切除术后总的并发症发生率为17.7%,手术死亡率为1.3%。单因素分析显示,年龄、肝门阻断、出血量以及术中输血等4项指标与并发症发生有关。多元逐步回归分析显示年龄、肝门阻断和术中输血这3项指标是决定肝癌切除术后并发症发生的独立的危险因素。结论降低肝癌切除术后并发症发生率的关键在于术中有效地控制出血及输血量,同时对伴存肝硬化的病人应尽量缩短肝门阻断时间。

Objective To study the factors associated with postoperative complications of resection of hepatocellular carcinoma. Methods Consecutive 378 cases of hepatecellular carcinoma between June 1988 and April 2005 at Xiangya Hospital were summarized retrospectively. Single-variant and multivariate stepwise regression model were used to analysis the factors associated with postoperative complications of resection of hepatocellular carcinoma. Results The overall morbidity rate and mortality rate were 17. 7% and 1.3% respectively. Single-variant analysis showed that the age,pringle maneuver, intraoperative blood loss and blood transfusion were associated with postoperative complications. Furthermore, multivariate stepwise regression analysis revealed that the age,pringle maneuver, intraoperative blood loss and blood transfusion volume were the independent risk factors of morbidity rate of resections of hepatecellular carcinoma. Conclusion The surgical excisions of hepatecellular carcinomas are safe and feasible only if the liver function reserve could be judged accurately before operation and the intraoperative hemorrhage and blood transfusion could be controlled effectively and the duration of portal clamping could be shortened during the operation.